What kind of doctor do I need to see?
September 17, 2010 8:39 AM   Subscribe

You are not a doctor, but you can hopefully help me determine which kind I need to go to.

Over the past few years some weird symptoms have been getting worse and worse. It's now to the point that it annoys family and coworkers so it's time to get things checked out. (Also, logically speaking, something that appears and steadily worsens is probably worth checking out, hm?)

Problem is, I don't know who I need to see. Maybe you don't know exactly who I need to see either, but I'd at least like some ideas and thoughts before I go in to my PCP (who I've never actually met -- recent insurance switching means I have new doctors) and lay things out for her.

So there are two threads here.

(a) I've found that I appear to be lactose intolerant. I've always hated milk anyway, and switched to soy milk in college for cereal and such, but continue to eat cheese and ice cream and so on. Since college I found myself coughing a lot immediately after eating dairy products and experiencing increased gasiness. Symptoms are somewhat alleviated when I take Lactaid. Figured I had it all under control, though that may just kind of be a placebo effect for a nonexistent intolerance, because...

(b) ... over the past year or so I noticed I was coughing like crazy after eating things I knew didn't have dairy, like a lot of Asian foods, the tea I drink in the morning, etc. The coughing became not just coughing but incessant but unproductive throat-clearing, as well as the sniffles, lasting up to an hour after I've eaten something. My coworkers can tell when I come in each morning because the sniffling and throat-clearing starts emanating from my cubicle. It's pretty bad. Through some googling, I think maybe it might be LPR? But I never actually have heartburn. I've tried self-medicating with some OTC PPIs, which sort of seems to help, but doesn't actually fix the symptoms.

Other possible relevant point: I have no history of seasonal allergies and experimenting with OTC allergy meds have no noticeable effect.


(1) What kind of doctor do I need to see? ENT? GI? An allergist even though I don't think that's it? Something else? Multiple?

(2) Does anyone else have experience with these symptoms? Did doctors send you on any wild goose chases, before arriving at your actual diagnosis, that I should watch out for?

(3) I freak the hell out at most medical procedures. Reading that testing for LPR involves things down my nose and throat incites a small amount of panic in me. If I do end up going in that kind of direction (or other similar procedures are needed with other doctors) any advice in handling them without too much anxiety?
posted by olinerd to Health & Fitness (15 answers total)
1) Relax and go see your new PCP. It might be weird to go see someone for a meet and greet to get acquainted (I just did that and it kind of was, because I kept shooting him tales of everything that had ever happened to me in hopes that it would be mildly relevant :P), so consider yourself lucky that you have something to ask about :) The PCP will likely have some recs of her/his own, and if a visit to a specialist is needed, they can easily make that determination.

2) No idea. On another tangent, have you tried elimination diets? Also, stay away from turning into your own personal Dr. Internet. (One day you'll find pictures of terrible skin conditions and smokers' lungs, and that is just not okay.)

3) Bring a friend or partner, and remember that it's only temporary. It's only temporary. it's only temporary... Take an extra hour, or an afternoon, off from work if you need to, and give yourself a breather after that part.

Yes, having the thing down your nose is incredibly weird. You may be able to ask for sedation of some sort, or even asking your PCP for permission to get some Xanax if that's okay with the kinds of tests you'd have.

But these are all steps way ahead of the game. Go see your PCP.
posted by Madamina at 8:55 AM on September 17, 2010

First point of contact for a mysterious medical issue should almost always be a GP - they are your "central point of contact" for your care. A good internist or family medicine doc is a doctor's doctor - in addition to being excellent diagnosticians, they're good at managing the entire scope of your care, including appropriate referrals.
posted by julthumbscrew at 8:56 AM on September 17, 2010 [2 favorites]

Generally when the which-doctor-should-I-see-for-my-mystery-illness questions are asked, the answers are endocrinologist, neurologist, or gastroenterologist. In this case, though, I agree with stoneweaver--sounds like you should see an allergist. You may indeed be referred to a GI, but I would start with an allergist.
posted by phunniemee at 8:57 AM on September 17, 2010

1) Your PCP might actually be the best person to see for this, at first. Part of their job is to help you figure out what specialist is most appropriate, if they can't handle something on their own.

2) I know several people who have experienced similar symptoms. One turned out to have GERD (similar to the LPR you mentioned) and is now basically cough-free. However, it turned out that a lot of his problem was that he had developed the habit of coughing and clearing his throat, which continues to irritate the throat and lead to more coughing and clearing. He had to work pretty hard to break that cycle. Another person I know with similar symptoms has been tested for reflux and allergies and goodness knows what else over several years and still doesn't have an answer. I wonder if some kind of chronic sinus infection (with accompanying post-nasal drip) might also be a possibility.

3) If you do get a scope put down your throat, they will very likely give you some kind of drugs to help calm you down first. Depending on how far they want to look, they will probably also give you some kind of pain relievers and/or local anesthetic so you aren't uncomfortable, as well as some medications that make you not really remember the procedure. Make sure to tell the scheduler when you make an appointment, and the nurse when you first arrive, so that the doctor knows you are anxious and would like something to take the edge off.

Good luck, that sounds frustrating but I'm glad you're getting it checked out!
posted by vytae at 8:59 AM on September 17, 2010

This sounds like a job for a GI doc. Reflux doesn't always manifest as heartburn.

I had an upper endoscopy last year and if it's any comfort - the sedation was great and I don't remember any of it (and I am like you - fear of choking stops me going to the dentist).
posted by media_itoku at 8:59 AM on September 17, 2010

Lactose intolerance doesn't typically cause symptoms like coughing: the effects of it are much more often felt in the lower GI tract.

The doctor you should see for this is your PCP, and a specialist if she refers you - it's premature to be going to specialists when you've never even met the doctor who specializes in your whole body, rather than some particular disease condition or body system, which, whether or not it's the source problem, a specialist will automatically focus on because that's their job.
posted by strangely stunted trees at 9:02 AM on September 17, 2010

What's a PCP? I've not heard of the term. In the UK we have GPs (General Practitioners) whose job it is to answer precisely your question. Is there no equivalent you can see for an appropriate referral in your country?
posted by Biru at 9:10 AM on September 17, 2010

PCP = Primary Care Practitioner = American English acronym for a GP
posted by strangely stunted trees at 9:14 AM on September 17, 2010

The coughing is weird. Had it for probably a year solid. Always got worse with milk (which makes me sniffly, too.) They never did figure out what was wrong with me. It eventually went away, even though coedine didn't work.

Here's another vote for your PCP. You need to meet them anyway, and this way you know they can't do anything really traumatic to you at the first appointment.
posted by SMPA at 9:27 AM on September 17, 2010

Food sensitivities/food intolerances can have many and varied symptoms. They can start out mild and become worse over time, as you are describing. You can be intolerant to anything. Anything.

Both dairy foods and spicy foods cause increased mucus, which in turn can cause coughing and, of course, sniffling. IANAD, but I don't think medicine has a cure for this other than identifying which foods cause your problems and drastically reducing or eliminating them from your diet. You may want to keep a food diary in order to better identify what's going on. And you could see if switching to another type of tea helps, or changing what you put in your tea.
posted by serena15221 at 10:12 AM on September 17, 2010

BTW, when I said "I don't think medicine has a cure for this" I didn't mean "don't bother to go to a doctor". A doctor could still help, although I don't know which kind would be the best. If it does turn out to be food sensitivities, you might be referred to a nutritionist.
posted by serena15221 at 11:52 AM on September 17, 2010

And I would bite the bullet and skip the tea entirely for a few days and see what happens.
posted by serena15221 at 11:54 AM on September 17, 2010

I say, see an allergist AND a gastroenterologist. Even if it is an allergic reaction, much can be learned from an endoscopy. It's all triggered by food, so there could be a compounding factor in your gut.

Good luck!
posted by Citrus at 12:25 PM on September 17, 2010

> First point of contact for a mysterious medical issue should almost always be a GP - they are your "central point of contact" for your care.

Exactly what I was thinking. "You are not my doctor" is the same as "you are not my provider of specialist-referral advice".
posted by AmbroseChapel at 6:05 PM on September 17, 2010

2nding media_itoku: sometimes reflux (GERD) manifests as cough
posted by onegoodthing at 8:12 AM on September 18, 2010

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